Endocrine Abstracts

Objective: Assessment of the health status in a population from a territory with apparently normal iodine intake may take in consideration the incidence of goiter as a mass pathologic process. Considering goiter as a result of both endogenous and exogenous factors, the study of its incidence and correlations with potentially goitrogens represents a prophylactic medical activity. Use of the term ‘paraendemic’ for a certain territory does not justify a ‘relaxation’ of the medical activity concerning the goiter problem.

Materials and methods: Healthy and goitrous inhabitants of Dobrogea region have been examined. The region has been arbitrarily divided into four areas: Seacoast area, Central Dobrogea area, Peri-Danubian area and Tulcea area. The study consisted in the clinical evaluation of thyromegaly, measurement of thyroid volume, assessment of thyroid function, incidence of thyroid autoimmunity and its correlations with gender, age, thyroid volume, place of living, cigarettes smoking, involvement of polluting goitrogen factors and biochemical characteristics of the underground waters.

Results: An increased prevalence of the goitrogen process has been found, with an ascending percentage within the last 14 years. The mean thyroid volume in healthy subjects (13.42±1.2 ml) was minimal in Seacoast area (10.1±40.4 ml) and rose progressively in Peri-Danubian area (15.8±0.7 ml) toward to Tulcea area (17.9±0.8 ml), with differences according to gender and age. The associated functional abnormalities have been represented by increased prevalence of subclinical hypothyroidism (SCHT) (14.6%). TPO-Ab level (representing the thyroid autoimmunity) has been found elevated in the general population (11.1%) and in the hypoechoic goiter bearers (53.5%). A high concentration of polluting goitrogens has been found in Danube and underground water, mostly characterized as intense mineralized water.

Conclusions: Inhabitants from an even limited territory may present significant variations of thyroid structure, volume, and function, with various pathologic consequences.

The relatively high prevalence of non-toxic goiter in a territory without iodine deficit could be correlated to other goitrogen factors like autoimmunity and different polluting agents.